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April 29, 2009

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In his interview with David Leonhardt, Obama touches -- in unusually personal terms -- on one of the hardest-to-discuss realities of searching for healthcare savings: That many are to be found in end-of-life care.

Obama suggests he would have paid out of pocket for care for his grandmother that might not be rational for a state-backed system to provide.

It is, Obama says, "very difficult to imagine the country making those decisions just through the normal political channels."

Q:...where it’s $20,000 for an extra week of life.

THE PRESIDENT: Exactly. And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.

So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.

And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.

I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

Q: And it’s going to be hard for people who don’t have the option of paying for it.

THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

Q: So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

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A very grown-up conversation that America is not used to having with its political leaders. I'm not sure how people will feel about this, but it's the sort of tough medicine we will have to take if we are going to actually lower health care costs instead of just talking about it.

Yeah, wow, I don't know what I'd do in a similar situation. I'm just really glad we have someone in charge who is smart enough and good enough to see the problem and recongize it for what it is. How sad.

We have to understand that those end-of-life decisions are right now driven by two things - wealth and/or the decisions of insurance company bureaucrats. Obama made that clear when he said he would have paid for his grandmother out of pocket if the insurance company had denied the hip replacement. This will be a painful conversation.

While I sympathize on the death of his grandmother, to use it as tool for passing nationalized healthcare is reprehensible. Nowhere in his answers did he explain that nationalizing healthcare doesn't erase the associated costs. That hip replacement will still cost the same amount, only now, instead of HIS family having to make the decision to do it, the government tells all of us we're doing it for them. It's an intrusion on the personal liberties given to all of us by the constitution.

Don't worry. Obama's plan is to ration health care. Your doctor will go to a computer terminal and punch in your info. The hourglass will come up on the screen as the system works. You'll either be approved or denied, regardless if you can pay for out of your pocket. Welcome to National Health Care. Don't worry about the Political class, I doubt the National Health Care will affect them. Enjoy Obama having this 'Show' conversation over and over with you, he's just smoozing you lemmings......because the decision has already been made for you... Why do you think they want you health records in electronic format and uploaded??

Get a life all of you period --Pres Obama said all need to get guidance and their are moral issues all at different times we face with..easy for the rich they just hand the money over right..but Pres Obama personal pain he thought about those who do not have the money for their loved one. And that is what Pres Obama is compassionate about --not just the 1% but all yes all human beings suffering on different levels.....Ameicans need to get their hands out of their pockets and more worried about money and if their taxes go up for things that are really important--and does not take care of tax cuts for the rich...to get richer that is all the rich is worried about..money becomes their god!

Having worked as an RN in a rehab.hospital for many years and participated in "codes"which at times
were successful in reviving pts.some
pts."coded 3x in a 24 hr.period.Some
were in their 90's with multiple
systems failing(on dialysis,having a pacemaker,oxygen needed 24/7(and
respiratory tx 4X daily,abdominal
aneurysms,History of Pulmonary
embolisms,DVT's(blood clots in leg)
diabeties,I'm recalling one patient
who had all of the above and had a
cardiac arrest,was "coded"then 30 min.later had a respiratory arrest and 2nd attempt to revive the 93yr old was unsuccessful,about 30 family members arrived and were very demanding about what was done.
Nevermind his previous "quality of
life"I'm guessing the new Health Czar would determine it was not "cost effective" to resucitate such
a patient only to put him on ventilator...

Hey Dems, remember this: the evil Republicans will, one day, run the government again. You know what that means, don't you? Republicans like Bush, will have access to all of your health records and will have control over what treatments you can and cannot have. Do you want that? Once you give the government this power -- They will use it -- both Republicans and Democrats.

Americans are not supposed to have these types of conversations with their government, that is why it has never happened before. If the cost of healthcare is to be lowered how about putting a cap on these phony mal-practice lawsuits doctors have to carry millions of expensive litigation insurance just to practice. If we wanted government medicine we could move to Canada!

Pres Obama could pay not to see his grandmother suffer so in last few weeks if need be.................But Pres Obama is being compassionate about those of us who do not have the cash or money or means to help their loves ones till they pass so they will not suffer so much------------------ SOMETHING HAS TO BE PUT IN HEALTH CARE PLAN THAT WILL COVER THAT COST IS WHAT PRES OBAMA IS SAYING.. IDIOTS? -----------that is what the Pres Obama is trying to say we all need everyone's input--their personal stories--their needs--rich do not need to worry about cost do they? ----------That has to be very painful to watch a love one go through that till God brings them home............No civilized Nation who has ""full Heath Care" do not have to worry about that it is in the Health Care Cost Plan for all...poor middle class everyone-------------if is fully covered period...and all needs are taken care of till their love one passes...........we are just being ignorant of things we do not know because we are more worried about paying more taxes for good Health Care..---No cash ever crosses hands ever in those countries..all you do is hand them your health card when you enter the hospital--in admitting --all is done---no worry no stress no losing your homes or going into massive debt--all doctores are your choice all care all decisions are all yours--PERIOD.. more republican evil sick fears --fear mongering--republicans are fighting for big business (not you) insurance companies who are in the business to make money---period--deny deny deny deny!

Hmm Canada who has "full Health Care" coverage for all--is thanked today for helping to produce a drug to fight this flu.thank you.....Canada and your soldiers in Afgan.........Canada has put in laws for lawsuits against doctors for their protection. Laws also for patients also--fair ones....and also where doctors cannot over "charge" put out their own pricing also..works both ways--keeps cost down and fair for all -----prices are the same with all doctors..dentist what ever all over--no over charging or outrageous pricing on a whim............. All pricing the same for all Doctors it is law. Doctors cannot put in bills saying they saw 70 patients in one day..either..not good health care for patients either --every 15 minutes--to give proper personal attention and care on doctors visits..sad for us--all going with out good health care for our loved ones..and children!

This shows he really understands the issue. Everyone wants health care, but most of us are scared of turning our situations over to the government. I don't know how they'll work this out. But glad to know they understand some of the issues regular folks are worried about.

Nothing is free--full Health Care is good when Government controls it why they pay the bills and creates more jobs also..and keeps it equal and fair for doctors and patients NOT IN IT TO MAKE MONEY --FOR NO MONEY OR PROFIT IS MAKE PERIOD!--never worry of losing your house or being denied denied..or having to have cash on hand or where are you going to get the cash from...no cash changes hands all registered all have their health cards..Id etc..my sister lives there..and all have a very good life and live in beautiful homes cars enjoy all things save same as us...comes off of pay checks..or companies put in..all making a good living what is our problem ---fear mongers--

This is another issue above this president's pay grade (just like abortion). I'm sure just like with embryonic stell cell research (which is basically unnecessary due to all the breakthroughts with adult stem cells) he'll soon tell us that only "science" should decide this and not "idealogy" which is his way of telling people of faith to butt out. You'd think we were a nation founded by atheists the way he talks. BUt we're not. God has always played a large role in this nation and needs to again so that we don't continue spiraling towards moral bankruptcy. Rationing of medical services is what Hitler Germany did. When we begin deciding whose life is more "productive", we make ourselves into little gods and seal our own destruction as a nation. God help us and guide us!

"EVERYTHING IS fREE"If hOSPITALS are
OWNED& OPERATED by govt rules and regulations who is paying for that
operations?!"All doctors paid the
same..Do you think a podiatrist who trims diabetic toenails should receive same $$as a cardiologist or
neuro-surgeon(brain surgery requires more risk & skill...but hey the extra yrs& $$$ debt incured
from med school,residency should not concern those receiving "free
healthcare"Govt.providing "free"Mal-practice coverage for M.D'sWow,Who is this super-rich Nanny Govt that takes care of us all?Oh ,paid by govt.means paid by
taxpayers?!Wait..don't confuse me with the facts ..ONLY 41%of current
pop.pays income tax and "baby boomers (millions)will retire in next 5-10yrs and hit the already
bankrupt Social Security system,tAX
CHEAT tIM WILL CONTINUE RUNNING THE
PRINTING PRESSES TIL THE u.s DOLLARS ARE WORTH AS MUCH AS TOILET
tISSUE?!mAYBE HANDY when the Sh--
hits the fan!!

How wonderful to have a president in the White House who is thoughtful and can tolerate debate of divergent ideas - the definition of an adult is a person who can hold 2 divergent ideas in his/her head at one time.
There are many important aspects to this interview: one is that the pt and her doctor made the decision together. The second is that despite the best intentions medical treatment doesn't always provide the expected results. Medicine isn't just a science, it's also an art.
Clearly there are complicated ethics issues that will require a great deal of discussion as we, as a country, move foward with health care reform. I'm just so grateful that finally we have a role model for intellegent, adult thought.

Why are republicans such morons? The man is talking about folks on medicare and medicaid and presumably a single payer public option. Basically tax funded insurance programs. If you don't like it. KEEP THE INSURANCE YOU HAVE. You still have the freedom to do that in America. Obama's health care plan doesn't change that one bit.

Obama is incredible. He is analytical and intelligent but he is also balanced by thoughtfulness and a huge heart. I felt so sad reading how his grandmother "fell apart." God bless her. We are so lucky to have this man as our president.

God is not asking any mere mortal to decide when life begins, knows we are mere mortals period...above my pay grade--sad that some do not understand that answer..was referring to God--a spiritual answer..not given that authority nor was Jesus given that authority to judge no one either that would be sin period....republicans abortion abortion gays gays gays over over again.....follow and obey Gods word--mere mortals do not get that either--not your or my job to do so..-----Pres Obama was asked get your facts straight--when does life begin...not in my pay grade-I am a Catholic and knew the depth and it was a spiritual answer referring to God! -- Not what Pres Obama is here on earth to do..not given that authority or job to accomplish on earth period.but to serve spread the good news and follow Jesus his actions the gospels--..but to obey God in all things -- believe in God, serve others, forgive etc..................republicans were rationing medical services when republicans stripped Pres Obama's Flu Pandemic Preparedness from the Stimulus Package--calling it ""PORK and WASTE OF MONEY'''now look--republicans are deciding who's life is more productive--gays are not? abortion they only use to get votes..God is helping us, sent us Pres Obama--who believes in Jesus, has morals dignity repented of our arogance--but pointed out also Europe has their fingers judging us also..republicans sound more like atheists listen to their words, judging, bashing, lies, twist and spin false accusations.. slander, hate, degrading remarks slander toward others and our Pres..republicans even used God's most faithful servant Moses, mocking God to bash Pres Obama in a campaign video..using Jesus most Holy Name to mock Pres Obama --please--to little gods--hmmm describes who republicans they think they are little gods and forcing their man made gospel to put fear in others? Not Jesus gospel --wolves in sheep clothing..evil works does not wipe out evil works--sinners judging sinners..Not even Jesus judge anyone that would be sin and disobedience to God's WILL TO GIVE ALL FREE WILL TO CHOOSE THAT IS SIN TO FORCE ANYONE AGAINST THEIR WILL--God knew all things before they would come to pass--nothing knew on the face of the earth---God gave the Ten Commandments that is his foreign policy period...

I too am so proud that we have a role model who provides me with free koolaid for me to drink. He blesses me with his light and feel warm when gazed upon by the anointed one. I can wait to leave this earthly bound to join the Messiah, The One: Obama

The only way to get free/afforadalbe health care in this country is to be an illegal allien. How about them apples , sad but true. If your an American we will just let you die in the street , because your pockets are empty . But then again we all should be paying 500-1000 a month for insurance right, so the health care industry can get as big as our government. It's all about the money babe it's all about the money.
Money = life
Empty pockets = death
Half Full pockets may get you a 100-300 a month prescription.
Got to love it!!!

God Bless our dear Pres Obama to get us back on the moral track..while his grandmother was ill thinking compassinately about our troubles those who do not have the money to help their love ones from further pain and suffering..that is why it is important to gather all all Americans in an open discussion on health care--for all our needs and added cost to be there when needed..rich do not have to worry-have the money, but what about the rest is what Pres. Obama is worried about..plan for cost, help for all those who have loved ones--to provide cost for that....when they need it..

I do not want the government to decide whether I am worthy or not to receive treatment in my last days. That is a decision only my family and I should make. I have paid for my insurance all my life and feel it's not a GOVERNMENT decision but a PERSONAL one. Obama's discussion about his grandmother is convenient for him. He is a master at illusion and has you all fooled to promote his socialistic government medical care system. WAKE UP!!!

What many don't realize is that that people are currently making this choice EVERY day.
It's an uncomfortable discussion when, for instance, an oncologist has to tell patients that they have to make the choice whether to pay for cancer treatment because their insurance won't cover it, and the doctor can no longer subsidize it by continuing to pay for it without being reimbursed.
I hope that the Administration will include a number of community doctors in this "big conversation" he is planning. They see, treat and talk to regular folks every day.

That's just horrifying. Really.
We'll take a vote to see if you get medical care, then we'll make sure that vite is correct by running past a group of experts who may or may not have the same values as you do.